Skip to main content

Full text of "Interpretation of dental radiographs"

See other formats


West Virginia University Libraries 




3 0802 102296245 9 



11 

■ 1 • 


Cm 







nzz 



DO NOT CIRCULATE 



Digitized by the Internet Archive 

in 2012 with funding from 

LYRASIS Members and Sloan Foundation 



http://archive.org/details/interpreOOgree 



INTERPRETATION 

of 
Dental Radiographs 



A. L. Greenfield, D.D.S. 

Lecturer on Radiology and 
Director of X-Ray Clinic 
at The New York College of 
Dentistry, New York Citv. 



"Published by 

Ritter Dental Mfg. Company, Inc. 

ROCHESTER, NEW YORK 



I 






COPYRIGHT I92j 

BY 

R1TTER DENTAL MFG. COMPANY, INC. 

ROCHESTER, N. V. 



INTERPRETATION OF DENTAL 
RADIOGRAPHS 

Chapter I 
^Appearance of ^formal ^Dental "Tissues 

The dental radiograph in the broadest sense is a representa- 
tion of the density or radiability of the dental tissues. The 
denser the object or tissue to be x-rayed, the lighter will be the 
appearance of the negative or film immediately beneath that 
tissue. Vice versa, the less the density of the part to be radio- 
graphed, the darker will be the film. Dense tissue, then, is 
characterized by white areas, and less dense tissues by darker 
areas. Absence of tissue or soft tissue appears black. 




Fig. l 

Figure I shows a radiograph of a tooth in its alveolus. (A) represents an amalgam filling, which 
being dense appears white. Very clearly seen (B) is the enamel which is light but not quite as 
white or transparent as the amalgam filling. This is due to the fact that it is not quite as dense. 
(C) shows the dentine and cementum which make up the bulk of the tooth. These structures 
being less dense than the enamel appear gray. The pulp chamber and canals being soft tissue, 

show as dark areas. 

Filling materials such as amalgam, oxy-phosphate and oxy- 
chloride of zinc cements, chlora-percha, etc. are white. Syn- 
thetic cement or porcelain appears gray, and if a hard tube or 
rays of great penetration are used, it appears black. 

Immediately around the roots of the tooth and entirely 
surrounding the root is a thin even black line (D). This repre- 
sents the space occupied by the peridental membrane. Normally 
this line is thin, even, and black. Immediately surrounding this 
thin, even, black line, is seen a thin even white line. This white 
line is the thin dense plate of bone which lines the sockets of the 

-*H[ i }•<:•<- 



Interpretation of Dental T\adiographs 
y =>t *"" 

teeth. It is known as the lamina dura or peridental lamella (E). 
This line normally is thin, even, and white and closely adheres to 
the dark line representing the peridental membrane. It should 
be noted, that when conditions are normal that this line en- 
tirely surrounds the peridental membrane and is unbroken in 
its entire length. These two structures should be carefully 
studied. Any deviation in their contour or relationship is 
indicative of some trouble. In a later chapter, it will be shown 
how these tissues are affected by pathological conditions. 

(F) shows the appearance of normal cancellous bone. It 
appears as a white network enclosing irregular black spaces. 
These black spaces are irregular in size and shape. It can also 
be seen that there is a harmonious blending of light and dark 
areas. In short there is no predominance of black or white 
shadings. To summarize — Normal bone has two characteristics: 

(a) Well-defined white network enclosing irregular black spaces. 

(b) Uniform distribution of light and dark areas. In destruc- 
tion or in morbid increase of bone, the uniformity of the distri- 
bution of light and dark areas is destroyed. Under pathological 
influences, the cancelli or network of bone, lose their well- 
defined appearance, and the black spaces tend to become 
regular in size. 

Chapter II 

zJfnatomic JTandmarks Found i?i 
Upper and jTower yaws 

Upper Jaw 

'7(adio/ucent or Dark J^andmarks 

Antrum of Highmore — This appears as a dark area with a 
heavy white line along its lower border. It is usually found 
above the upper molars. Sometimes it includes the bicuspids 
and canine. From the ordinary radiograph, it cannot be 
definitely stated that the roots of the teeth penetrate the 
antrum. Sometimes the negative shows the penetration of the 
antrum by the teeth, but this cannot be diagnosed with any 
degree of accuracy. A study of the diagram on the next page 
will show how roots may appear to enter the antrum, when 
in reality, they do not. 



'Twitter 'Dental <^Cfg. C om P a,n J> ^ nc - 
V8i ^ ^ 



Fig. 2 — Cross Section of Superior First Molar and Surrounding Tissue. 
A — Antrum. B — Tooth. C — Film. X — X-rays. 



The antrum is mistaken by beginners, sometimes, for a cyst. 
A little later in this chapter, it will be shown how this mistake 
can be avoided. 

Nasal Cavity — seen as a dark area a short distance above 
the upper incisors. 

Incisive or Anterior Palatine Foramen — appears as a dark 
area found between the upper central incisors. Sometimes, 
depending upon the angle at which the radiograph is made, 
this foramen appears over one of the incisors. In this position 
it is sometimes mistaken for a pathological condition. 

Nostril spots — show as dark areas over the incisors. 

'Radiopaque or J^ight J^andmarks 

Malar Bone — produces a light area above the superior 
molars. Sometimes this bone is so prominent that it is cast 
upon the molars and blots out details. 

Coronoid Process — While this is part of .the mandible, it 
frequently is seen in radiographs of maxillary molars. It 
usually is found distally to these molars. It is mistaken by 
beginners for an impacted or unerupted third molar. 

Nasal Septum — appears as a broad white vertical line sepa- 
rating the nasal cavity into two parts. 



tSSfc. 



Interpretation of 'Dental l^adiographs 



;VSV> 



ILLUSTRATING ANATOMIC LANDMARKS 




• 



) W 







t n , 



A — Malar Bone 

B — Antrum 

C — Anterior Palatine Foramen 



D — Nasal Cavity 
I- — Mental Foramen 
G— Lingual Tubercle 



M. 4 >f- 



'Twitter 'Dental zSftCfg. (/ompany, Inc. 



vsfl- 



4<5V 



ILLUSTRATING ANATOMIC LANDMARKS 








\ k i a 



H — Inferior Dental Canal 



Note: Dark area on Distal surface ot right lower first molar — showing a cavity. 



*C 5 }* 



Interpretation of Dental 'Radiographs 
•** «- IK=v 

Lower Jaw 

'Radio lucent landmarks 

Mandibular Canal — seen as a broad dark line extending for- 
ward from the ramus and runs horizontally along the body of 
the mandible and terminates in the mental foramen. 

Mental Foramen — appears as a small round radiolucent area 
below the bicuspids. This foramen is sometimes mistaken for 
an abcess about one of the bicuspids. 

Thin portion oj lower jaw near the angle oj the jaw — -This dark 
area is caused by the thinness of the bone in this region. It 
varies in different individuals. Great care should be taken 
not to mistake this dark area for a bone destruction. Usually 
this condition is bilateral and a radiograph of the same region 
on the opposite side will disclose the same condition. 

'Radiopaque landmarks 

External Oblique line or ridge — Seen as a white line at the 
beginning of the ascending ramus of the mandible. It some- 
times is so heavy that it obscures the roots of the mandibular 
third molar. 

Lingual tubercle — Shown as a small white area beneath the 
mandibular incisors at the symphysis. It is sometimes mis- 
taken for sclerotic bone or a bone whorl. 

It can readilv be seen that the radiolucent landmarks can 
sometimes be mistaken for bone destruction. If at all in doubt, 
try any of the four following methods to determine whether 
or not the dark area is due to a normal space in bone or to a 
pathological process. 

Vitality Test — test tooth for vitality. If the tooth responds, 
then the dark area about it is usually normal. However, great 
care must be taken in applying the vitality test. There are 
certain limitations to the test. Teeth with large fillings, or 
teeth carrying metallic crowns, may respond even though pulp- 
less. Vital teeth in which considerable secondary dentine has 
formed, will respond weakly or not at all to the test. Great 
care should be taken that the tooth to be tested is entirely 

-*H[ 6 )#- 



'fitter 'Dental cWfg. Company, Inc. 
VSt 16V 

isolated so that the electric current used for the test should not 
escape to the gum or adjacent teeth. If it does this, you are apt 
to receive a response even though the tooth undergoing the 
test may be pulpless. 

See if lamina dura is intact — The lamina dura, as has been 
explained, appears as an unbroken white line about the tooth. 
This white line is the thin, dense, layer of bone that lines the 
alveolus or tooth socket. Obviously there can be no involve- 
ment of the bone about the tooth as a result of direct infection 
or irritation through the tooth itself, unless this lamina dura 
is first broken or destroyed. Therefore, if the lamina dura 
appears unbroken, and continues about the tooth intact, it 
can be decided that the dark area is a normal space in the bone. 

Radiograph area at different angles — Take several radiographs 
at different angles. If the dark area bears the same relation- 
ship to the tooth in all the radiographs so taken, then it denotes 
that the radiolucent spot in the bone is caused by some patho- 
logical process. If the relationship between the dark area and 
the tooth differs in the radiographs taken at the various angles, 
then the condition is normal. Let us consider a concrete 
example. Suppose one radiograph shows a dark area about the 
upper right central. Then a radiograph is taken at a different 
angle. The second radiograph shows the radiolucent spot 
entirely separate and distinct from the apex of the upper right 
central. We can make a diagnosis in this case, that the dark 
area is the anterior palatine foramen. 

Around a normal space or foramen in bone, such as the 
antrum, etc., the white line surrounding the dark area is thick, 
heavy, and uneven. In a pathological destruction of bone, if 
the white line is present, it is thin, even, and white. 

Distinguishing Right and J^eft Sides 

So many people go to the trouble of using an elaborate system 
of marking the regions they have radiographed, upon the film 
so that they can tell what region was x-rayed when examined 
at some future time. This process is entirely unnecessary if a 
few of the following facts are observed: 

The shiny side of the film must be held towards the observer. 

-*H[ 7 ]H*-- 



Interpretation of ^Dental Jt\adiographi 



VS>(I- 



-JGV 



This gives what is known as a lingual aspect. With the film so 
placed, the examiner should imagine himself sitting inside the 
patient's mouth. This is just opposite to conditions pictured 
on the average dental chart. If the new translucent base films 
are used, the dull side must present outward. 

Then it must be determined whether the film is a radiograph 
of the superior or inferior maxilla. This can easily be recog- 
nized by remembering the landmarks found in the upper and 
lower jaws, and by the shapes of the teeth. For instance, the 
antrum or malar bone would immediately indicate that the 
radiograph was one of the upper jaw. The lower incisors 
could easily be distinguished from the uppers because of their 
difference in size and shape. The lower molars could not be 
confused with the uppers because of the difference in the num- 
ber of roots. 

When it has been determined that the radiograph is one of 
an upper or lower, then the apices must be properly placed. It 
we are dealing with the superior maxilla, the film must be so 
placed the apices point upward. The opposite should be done 
in the case of the lower jaw. 

Then find the distal end of the film. If we have a radiograph 
of two bicuspids and a molar, then the distal of that film would 
be the molar. 

The position of the distal end of the film determines whether 
the film is that of a right side or a left. If the distal is to the 
right, then we have a right side. If it is to the left, we have a 
left side. To illustrate: 




Fig. 3 — The distal in Figure 3 is to the right. The antrum and shapes of the teeth indicate 
an upper jaw. We can call this a radiograph of the upper right bicuspid and molar region. 



-*H[ 8 }<:-- 



j\itter 'Denial i%Cfg. Company, Inc. 



Chapter III 
Factors c Produci?ig 'Disease of TDental 'Tissues 

Let us for a few moments consider what are some of the 
causative factors of diseased dental conditions. The disease 
may manifest itself by destroying the dental tissues or by 
producing morbid growth or increase in tissue. The former 
produces what is known as a radiolucent (dark) area in the 
negative. The latter causes the production of a radiopaque 
zone (light). 

The radiolucent manifestations are caused by: 

Traumatic occlusion — This produces a diffuse dark area about 
the entire tooth. The destruction of the bone starts at the neck 
of the tooth and works upward or downward towards the apex. 
It produces a condition known as alveoloclasia. 

hack of occlusion, lack of use, or lack of proximal contact — 
This produces almost the same kind of change in the alveolus 
described in traumatic occlusion. 

Bacteria — This agent produces a localized or diffuse dark 
area about the apex of the tooth or at the point of irritation. 

Action of Chemicals — Arsenic or phosphorous produces a 
diffuse dark area due to its destructive action upon the tissues. 

Mild Irritation or Pressure gives rise to the production of 
a radiolucent or dark, localized, circumscribed area about the 
apex of the tooth. 

The radiopaque manifestations are caused by: 

Traumatic occlusion — This condition is characterized by a 
light area about the entire tooth. In addition to this radio- 
paque area there can be seen the thickening of the peridental 
membrane about the tooth, and also the increase in size of the 
lamina dura. 

-«H[ 9 }<*•- 



Interpretation of T)ental T^adiographs 
vs>l I S * 

Thermal shock upon the pulp — This produces a localized light 
area about the apex of the affected tooth. Usually accompany- 
ing this condition, we can see a recession of the pulp. 

Sclerosis or osteosclerosis — This is the production of dense, 
hard, bone which replaces the normal bone. It appears white 
and homogeneous in the radiograph. It is not made up of the 
white network as is normal cancellous bone. It lacks the can- 
celli and appears dense and compact. 

Sometimes, after the extraction of a tooth, the socket instead 
ot being filled up with normal new bone, is replaced by the 
hard compact bone. This is probably due to infection which 
causes a condensing osteitis, resulting in production of this 
hard bone. The sclerotic bone is sometimes called scar bone, 
or eburnated bone, or a bone whorl. 

Defense — Frequently a radiopaque area can be seen surround- 
ing a dark area about the apex of a tooth. This is thought to be 
an attempt at defense on the part of Nature. 



-*Ht I0 !H*~ 



T^ilter 'Dental zJtCfg. Company, Inc. 
Chapter IV 

'Diagnosis of Pathological (Conditions 

c Radiolucent Changes 

Pericementitis or Periodontitis — As was mentioned previously, 
the normal peridental membrane appears thin, even, and black 
and immediately surrounds the tooth. As soon as some in- 
jurious agent, whether it be mechanical, chemical, thermal, or 
bacterial acts upon the peridental membrane, a change takes 
place in this tissue. The membrane thickens or increases in 
size at the point of irritation. 

If the radiograph reveals that the peridental membrane is 
thickened in its entire length, it is an indication that the irrita- 
tion is outside the tooth. If the peridental membrane has only 
a local thickening, say about the apex or at a point of perfora- 
tion, we know that the trouble is from within the tooth. Trau- 
matic occlusion or lack of occlusion, will first produce a general- 
ized thickening of the peridental membrane. This is seen in the 
radiograph by an increase in size of the dark space or line 
between the tooth and the white lamina dura. 

Irritation from a decomposing pulp will first manifest itself 
radiographically by an increase in size of the peridental mem- 
brane at the apex. It can be seen from this that the peridental 
membrane is involved before we get any bone destruction. The 
membrane should therefore, be carefully studied in order to 
procure valuable information to prevent future trouble — 
namely in preventive dentistry. 

With the increase in size of the peridental membrane, the 
lamina dura is next affected. It loses its even contour and 
becomes irregular. It ceases to closely adhere to the peridental 
membrane, and sags in several spots. 

Periapical Disturbances — If the source of irritation is not 
removed, the bone may become involved and destroyed. This 
destruction may be accompanied by pain, swelling, etc., or may 
begin and continue without giving rise to any clinical symp- 
toms. 

-*t * * J*- 



Interpretation of jJental 'Radiographs 
t/a * rn^' 

In connection with the study of periapical disturbances, we 
must consider the difference between the alveolar abscess and 
the granuloma or pericementoma as some prefer to call it. The 
abscess includes a process of suppuration with the attending 
destruction of the tissues about the tooth and the formation of 
pus. The granuloma on the other hand involves the production 
of new inflammatory tissue. The granuloma formation is due 
to some mild form of infection or irritation or pressure, causing 
the growth of new tissue. Dr. Kurt Thoma in his book on Oral 
Roentgenology likens the granuloma to the production of new 
tissue in tuberculosis (tuberculous granuloma-tubercle) and 
syphilitic granuloma (gumma syphiloma). 

The abscess appears as a dark localized area, irregular in 
outline, about the apex of the tooth. The granuloma, depend- 
ing on whether it is still intact, appears in one of two ways. If 
the granuloma has not broken down, it appears radiographically 
as a dark, localized, circumscribed area about the apex of the 
tooth. It is seen as a dark area with a distinct white line about 
it. If the granuloma has broken down, we get the same 
appearance as we do in the case of the abscess — namely, a dark 
area irregular in outline. 

The granuloma with the distinct line of demarcation about it 
may develop into a cyst. In fact any radiolucent area having 
the above description, and if it is more than 3 s to }4 inch in 
diameter, can be regarded as cysts. A cyst has an epithelial 
lining which is impervious to fluids. This enables them to grow 
to such enormous size. The ordinary granuloma, having a 
fibrous capsule, would disintegrate long before it reached 3 s of 
an inch in diameter. 

It will be noticed that some radiolucent areas appear darker 
than others. It was thought some years ago that the contents 
of the destroyed area would cause the part to appear darker. 
Pus was thought to be radio-active and consequently would 
cause the production of a darker area. This is now known to be 
erroneous. It is the position of the abscess or granuloma rather 
than the contents, that determines the appearance of the radio- 
lucent area. If the process of destruction involves the cancel- 
lous bone only, then the area will be hazy in appearance. If 

-*>£ i 2 ]H&- 



'Patter 'Dental <^%Cfg. Qjmpany, Inc. 
V3|U *®* 

one or both plates of bone are involved, then the radiograph 
appears very dark due to the greatly lessened density. 

Very often a patient may present with pain, redness and 
swelling and a radiograph taken of such a case fails to show any 
signs of absorption of bone. This is due to the fact that the 
destructive process has not involved the bone. It is merely 
subperiosteal and therefore the radiograph fails to show the 
usual radiolucence. 

Cvst — It appears as a dark area with a thin white line about 
it. If a tooth is present in the cyst, we have what is known as a 
dentigerous cyst. 

Osteitis — Appears as dark area, indistinct and irregular in 
outline. Radiographically it resembles the alveolar abscess but 
it involves a considerably greater portion of bone. The dark 
area gradually merges into the surrounding healthy tissue. 
This disease may be acute or chronic. It may cause pain or be 
present without giving any signs. 

Necrosis — As does Osteitis, this condition appears as a dark, 
irregular, indistinct area, gradually shading out from the dark 
to the light healthy bone. It is usually accompanied with the 
appearance of sequestra or dead bone. Necrosis is usually the 
result of poisons or drugs. 

Osteomyelitis — This is a disease involving the medullary por- 
tion of the bone. The radiographic appearance of this condition 
is characteristic. It has the appearance of wormwood. 

Absorption of Alveolus, Alveoloclasia, Pyorrhea — These 
conditions are easily shown in the radiograph. The bone which 
normally should extend up to the necks of the teeth, becomes 
absorbed. The white network is replaced by a dark area 
wherever the bone has been destroyed. The edges of the 
alveolar crests are irregular. The peridental membrane, and 
lamina dura become thickened. 

The radiograph may also show what is causing the trouble, 
such as overhanging fillings, crowns, salivary calculus, etc. 

Caries — This condition shows as a dark area in the crown of 
the tooth. The radiograph is especially valuable in detecting 
this condition when it is present down at the neck of the tooth. 
When in this position, a cavity is likely to be overlooked in the 

-*€ ' 3 }*■ 



Interpretation of T>ental T^adiograpks 

1 16V 

ordinary routine examination. Then too, such a dark area 
appearing underneath a rilling will denote secondary decay. 
It thus can be seen that the radiograph can be of great value 
in preventive dentistry. 

Radiopaque Changes 

Sclerosis of bone — This condition appears as a denser or 
whiter bone. It may be brought about by traumatic occlusion, 
infection or thermal shock or in abnormal bone repair (See 
Chapter III). 

In bone repair, great care must be taken to see whether you 
have new bone forming or whether you have sclerotic bone. 
Normal new bone has the same characteristics of alveolar 
process, namely the white network enclosing irregular black 
spaces. New bone is a little lighter in shade than the old 
bone which it has replaced. Sclerotic bone has been described 
as dense and white and has no cancelli — in short, no network. 
Bone undergoing regeneration or repair shows the presence of 
little bridges of bone spanning the dark area. These bone 
bridges do not appear when the destroyed bone is being re- 
placed by sclerotic bone. 

Hypercementosis — This is sometimes known as exostosis. 
This condition is due to an increased production of cementum. 
It is seen as thickening or bulging out of the root. The root 
instead of tapering appears club shaped. 

Sinusitis — The sinuses being spaces in the bone, normally 
appear black. In order to make a diagnosis, an antero-posterior 
film must be made which show the sinuses on both sides of the 
patient. The relative densities are then compared. As was 
said previously, the normal sinus appears black. When the 
sinus becomes filled with pus, or fluid or with some growth, 
it becomes gray as it resists the passage of the X-rays to some 
extent. When one sinus appears gray or cloudy in comparison 
to the other sinus which shows dark, then it can be said that 
the gray or cloudy sinus is the affected one. 

Pulp Stones — These stones are due to some irritation of the 
pulp. They can be found in the pulp chamber or in the pulp 
canal. Being the same density as dentine, they are seen as 

-»H[ "4>< : -"- 



T(itter 'Dental <3tf.fg. (Company. Inc. 

grav bodies. Many authorities maintain that pulp stones are 
prolific causes of neuralgia. 

Salivary deposits in duets of glands — These stones can be 
readily seen as gray areas. The radiograph assists greatly in 
their location and removal. 

Conclusion 

Before closing, I wish to impress upon the reader that the 
entire radiograph should be closely examined. The area about 
the apex of the tooth should not be the only part examined. 
The examination should include the crown, neck, pulp chamber 
and canal, peridental membrane, and lamina dura. By doing 
this, much valuable information which can be used to prevent 
future troubles, can be obtained. 

The crown may show presence of caries which would other- 
wise be overlooked by the operator. Caries can also be demon- 
strated radiographically at the neck of the tooth or under a 
filling. Deposits of salivary calculus can also be seen. The 
peridental membrane and lamina dura will give the observer 
an opportunity to see whether the tooth is in traumatic occlu- 
sion, lack of occlusion, or whether the trouble originates from 
within the tooth. The lamina dura and peridental membrane 
are the first structures to be affected under abnormal condi- 
tions. A study of them is therefore important in that phase of 
dentistry known as preventive dentistry. The pulp chamber 
may show the presence of pulp stones or new or secondary 
dentine. 

In other words, the radiograph should be used not only to 
discover present diseased conditions but also to prevent trouble 
at some subsequent time. Full-mouth x-ray examinations are 
strongly advised before attempting treatment. The x-ray 
machine should be used almost as much as the dental engine. 



-M. » 5 >« 



<*$)&. 



Interpretation of Dental 'Radiographs 



-16V 



PERICEMENTITIS 

(Periodontitis) 





Fir-. 4 





Fig. 6 



FiG. 





Fig. 8 



Fic. 9 



-*£i6; 



l ]^ificr 'Dental zJfCfg. C om P an Uy * nc - 

V3 t - — <<5V 

Fig. 4 

Shows a marked generalized thickening of the peridental 
membrane about the buccal roots of the first upper right molar 
and on the distal of the root of the second bicuspid. This is 
probably due to the overhanging filling on the mesial surface 
of the first molar. This filling is pressing on the second bicus- 
pid. The overhanging filling is already causing an absorption 
of the bone between the second bicuspid and first molar. The 
absorption is seen as a dark area just beneath the overhang 
of the filling. 

Fig. < 

The peridental membrane on the distal side of the root of 
the upper left cuspid is thickened. This increase in size of 
the peridental membrane is very common in fixed bridgework 
shown in this radiograph. Note the presence of an apex of a 
root just under the bridge mesially to the first molar. 

Fig. 6 
Presents an interesting case of traumatic occlusion. The 
radiograph shows the occlusal surfaces of the teeth all worn 
down. The pulps have become very much smaller due to the 
formation of secondary dentine. Pulp nodules or stones (small 
gray bodies) can be seen in the pulp chambers of the three 
lower right molars. The peridental membrane about these 
teeth shows a considerable increase in size. The lamina dura 
seen as the white line surrounding the dark peridental mem- 
brane is very much thicker than normally and is irregular in 
outline. The cancelli of bone are regular instead of irregular. 
The bone also shows a predominance of lighter shadings showing 
that a sclerosis is taking place on account of the trauma it is being 
subjected to. Irregular gray particles attached to the proxi- 
mal surfaces of the teeth are deposits of salivary calculus. 

Fig. 7 
Peridental membrane and lamina dura about lower right 
first molar show a great increase in size. This is due to the 
pressure being brought to bear on the first molar because a 
buccal appliance is wired to it. 

Fig. 8 
The lower right cuspid and first bicuspid are pulpless teeth 
showing evidences of root canal fillings. There is a generalized 
thickening of the peridental membrane. Just distally to the 

-*H[ i 7 }<*- 



Interpretation of Dental i\adiographs 

vat - — K»v 



PERICEMENTITIS 

(Periodontitis) 




LmJ 



Fig. io Fie. ii 




'4 4 



I 




Fig. 12 Fie. I 





Fig. 14 Fig. i< 

-*>{ 1 8 >*■- 



'Ratter 'Dental zJWfg. Qompanij, Inc. 

first bicuspid can be seen the socket of the recently extracted 
second bicuspid. 

Fig. 9 

Generalized thickening of the peridental membrane about 
lower left first molar and second bicuspid. In Fig. 4, 5, 6, 7 
and 9, note how the lamina dura also increases in size and 
becomes irregular in outline. 

Fig. 10 

The superior centrals show a thickening of the peridental 
membrane. This is due to loss of proximal contact. These 
teeth have drifted or moved on account of extraction of the 
laterals. This shows the importance of immediate restorative 
work. 

Fig. 11 

Shows a pericementitis or periodontitis about the lower 

incisors. 

Figs. 12 & 13 

These are radiographs of the lower right bicuspid and molar 
regions. The occlusal surfaces show signs of wear or attrition. 
This form of traumatic occlusion manifests itself in the radio- 
graphs shown, by a thickening of the peridental membrane and 
lamina dura, and the production of radiopaque (light) areas 
in the bone, especially seen in Fig. 13. 

Figs. 14 & 15 

Both show pericementitis. In addition there is a bulging 
out or enlargement mesio-distally of the roots of the upper 
left second bicuspid (Fig. 14) and the lower right first and 
second molars (Fig. iO- 



tj'eXU 



1 nter pretation of 'Dental 'Radiographs 



-Dsv 



GRANULOMA 





Fig. i 6 



Fig. 17 




Fig. 18 





Fig. 19 



Fig. 20 



-*{ 20 ><*- 



'letter 'Dental zJtCfg. Company, Inc. 
vac \&? 

Fig. 16 

The superior left temporary cuspid shows a small localized 
dark area about its apex. This dark area has a distinct white 
line about it — in short there is a distinct line of demarcation 
present between the dark area, and the white network indica- 
ting healthy bone. This is a granuloma. The granuloma pre- 
sents a picture of a small localized dark area with a distinct 
white line about it. Note the presence of the upper impacted 
left cuspid. In spite of the fact that the permanent cuspid 
is not pressing on the temporary one, there is a slight absorption 
of the root of the temporary cuspid. 

Fig. 17 

The upper left lateral has a porcelain filling on its distal 
surface which is very close to the pulp. This has probably 
caused the death of the pulp with its subsequent results. The 
lateral shows the dark area with the distinct white line about 
this area. This is another case of granuloma. Note the gener- 
alized thickening of the peridental membrane about the cus- 
pid which is carrying a fixed bridge. 

Fig. 18 

Superior right central lateral and cuspid, each show the 
presence of a granuloma. The central and lateral show evi- 
dences of root canal fillings. In both cases the root canal 
rilling (white lines seen in the dark canals) extend only about 
half way up the canal. 

Fig. 19 

Large cavity (dark area) is seen on the mesial surface of the 
upper left lateral. This caries involved the pulp and caused 
the death of that organ. A granuloma is present. 

Fig. 20 

Large granuloma seen about apex of superior right lateral. 
The dark area seems to overlap the central slightly. It prob- 
ably has not affected the central but is lapping over either 
buccally or lingually to the right central. A vitality test of the 
central would indicate if it has not become involved. 



Interpretation of 'Dental 'Radiographs 



VSfu 



-JSV 



GRANULOMA 





Fig. 21 



Fig, 22 





« k 






Fig. 1% 



Fig. 



-*>£ 22 J<*- 



'I\it1er lJcntal zSACj'g. Company, Inc. 
V3(l ~ ')6V 

Fig. 21 

The superior right cuspid is here seen carrying a bridge. 
The canal is only partly filled and there is a small granuloma 
at its apex. 

Fig. 22 

Large cavity seen in the entire crown portion of the superior 
right first bicuspid. Granuloma present. 

Fig. 23 

Caries present on mesial surface of the superior left second 
bicuspid. The cavity involves the pulp. A granuloma is seen 
about the apex of this tooth as well as the crowned first bicus- 
pid. At the gingival margin of the inlay on the mesial surface 
of the first molar is a dark line. This indicates a space between 
the inlay and the tooth structure. This is probably secondary 
decay or else shows that the inlay never really was properly 
fitted. The x-ray is of great aid in detecting such conditions 
and is thus of great use in preventing future serious diseased 
conditions. 

Fig. 24 

Shows a filling (white) in the occlusal surface of the lower 
left first molar involving the pulp. Granuloma present about 
distal root and a pericementitis on mesial. The bone imme- 
diately surrounding the granuloma on the distal root appears 
dense and white. This is probably Nature's means of defense 
against the granuloma. 



23 >*- 



Interpretation of "Dental l^^adiographs 



vei. 



-isv 



PERIAPICAL ABSORPTION 

(Diffuse) 




., \U 




Fig. 2; 



Fig. 26 




Fig. 27 




■ 



Fig. 28 



Fie. 2c 



-«►{ 24 }<i- 



'fitter 'Dental zJWfg. Company, Inc. 
V5X I — l«v 

Fig. 25 

The superior right lateral shows a diffuse dark area about 
its apex (periapical absorption). Unlike the granuloma these 
diffuse areas of periapical absorption merge into the surround- 
ing tissue. There is no distinct line of demarcation present 
but a diffuse dark area. 

Fig. 26 

Filling on mesial surface of superior right lateral involves 
the pulp. Diffuse area of periapical absorption seen about 
its apex. 

Fig. 27 

Large diffuse dark area present about the upper right lateral 
extending about the apex and down the sides of the root. 
The dark area seen immediately underneath the crown on 
the lateral denotes the presence of caries. The central and 
cuspid show evidences of root canal fillings — the lateral does 
not. The dark area seen mesially to the central (to the left 
of the central) is the anterior palatine foramen. 

Fig. 28 

Shows a diffuse radiolucent area about the entire mesial 
root of the crowned lower right first molar. The process of 
destruction has caused a fracture of the mesial root. The 
gold shell crown on this tooth fits very poorly, overlapping 
about one-quarter of an inch. 

Fig. 29 

Cavity (dark area) on mesial surface of lower left first molar 
which involves the mesial horn of the pulp. Large area of 
periapical absorption seen taking in a considerable portion 
of bone about both roots. It can be seen that the dark area 
shows a hazy appearance and the presence of cancelli. This 
indicates that the process has only involved the cancellous 
bone and has left the outer dense plates of bone intact. 



-*H[ 25 }**- 



Vdt- 



Interprelaiion of "Denial T{adiographs 



-KSV 



PERIAPICAL ABSORPTION 

{Diffuse) 





Fk,. 30 



Fie. -ji 





w 



Fig. 32 



Fig. 



-*H[ 26 }<*- 



l I\illcr "Dental zJufg. (Jam/pany, Inc. 
van -us* 

Fig. 30 

Gold shell crown on lower left first molar shows the presence 
of caries underneath it on distal surface at the gingival margin. 
Filling material is present in the pulp chamber. Large areas 
of periapical absorption merging into the surrounding healthy 
bone present about both roots. In addition there is an absorp- 
tion of the cementum of the roots. Such a tooth is commonly 
known as a "dead" tooth. It would be folly to attempt canal 
work on a tooth which shows absorption of cementum, if this 
necrosed tissue is not removed by means of root amputation. 
Large cavity seen on mesial surface of second molar. 

Figs. 31 & 32 

The superior left lateral (31) and lower left first bicuspid 
both show evidences of root canal fillings which do not reach 
the apices. Small diffuse areas of periapical absorption present. 
In Fig. 31, the lateral is carrying a detached post porcelain 
crown. 

Fig. 33 

Lower right first molar — considerable area of diffuse peria- 
pical absorption. There is also present an absorption of the 
alveolus between the two roots. 



vat— 



Interpretation of Dental l^adiographi 



-isv 



CYST 




Fig. 34 




Fig. 35 



-»i z* }<■<•- 



'Twitter Dental <L%Cfg. Company, Inc. 

V*5) fl 16V 

Fig. 34 

Large cyst present extending from the lateral to the bicus- 
pid on the left lower jaw. Note the dark area with its distinct 
white line about it. This is a typical picture that a cyst 
presents. Radiographically the cyst appears the same as a 
granuloma, but as explained previously in the text, the cyst 
attains a much larger size. A true granuloma would break 
down long before it would reach the size as shown in this 
picture. 

Fig. 35 

This figure shows the presence of a cyst in the lower jaw 
with a lateral and cuspid contained in it. A cyst which has 
one or more teeth in it, is known as a dentigerous cyst. In 
addition in the upper jaw an impacted cuspid is present under- 
neath the bridge. Immediately to the left of the lower cuspid 
is a small dark area. This is the mental foramen. 



-H 2 9: 



Interpretation of 'Dental ^Radiographs 



vsi. 



-*5* 



CYST 





Fie. 36 



Fig. 37 





Fig. 38 



Fig. 39 



-*{ jo >*■ 



'fitter 'Dental zJMj'g. C om P an !J' ^ nc - 

Fig. 36 

A large cyst can be seen involving the upper jaw on the 
left side extending from central through the first bicuspid 
region and across the median line. Note the dark area with 
its distinct white line of demarcation. The lateral and cuspid 
extend into the cyst and the cementum about the lateral is 
absorbed. In the upper left hand corner of the radiograph, 
is seen a dense irregular white body. This was found on opera- 
tion for removal, to be a piece of shrapnel. A root is present 
underneath the bridge on the left side in the first bicuspid 
region. 

Fig. 37 

Shows a large cyst involving almost the entire superior 
maxilla. 

Fig. 38 

This figure presents a multilobular cyst. It is made up of 
several dark areas with distinct white outlines overlapping 
one another. 

Fig. 39 

Just in the middle of this radiograph extending from central 
to the first molar is seen a cyst. The cuspid root projects into 
the cyst. The cuspid shows a root canal filling extending 
about halt way to the apex. There is a fixed bridge shown 
which extends about the entire upper arch. 



hss* 3 1 >* 



Interpretation of 'Dental Tiadiographs 



<*®tt 



-1GV 



CYST 




Fin. 40 





Fig. 41 




Fig. 42 



Fig. 43 



HtH[32>* 



'Ratter 'Dental <i^Cf(j. Qompany, Inc. 

Fig. 40 

Shows the presence of an abnormally large cyst which in- 
volves the entire ramus of the mandible. Not only does it 
involve the ramus but it extends forward involving the second 
molar region. 

Fig. 41 
Cyst present about superior right central and lateral. 

Fig. 42 

The left central crown portion of the tooth is missing. A 
large cyst extending from the median line to the cuspid is 
present. 

Fig. 43 

Shows an edentulous mouth. A small cyst is seen just in 
the median line. Note how clear and distinct the white line 
is, surrounding the dark area. 



-M. 3 3 ><*- 



Interpretation of 'Dental 'Radiographs 



Vi*. 



-KSV 



ALVEOLOCLASIA {Alveolar Absorption) 





Fi 



G. 44 



Fie 



45 





Fig. 46 



Fig. 





Fig. 48 



Fig. 49 



-H 34 }<*- 



Twitter 'Denial <^Cj'g. Company, Inc. 

V f -- fgfca 



Fig. 



44 



Superior right molar region. This radiograph presents a 
tvpical case of alveolar absorption. The white network which 
represents normal bone should extend down to the necks of 
the teeth. In Fig. 44 it can be seen that the white network 
has been replaced by dark areas, denoting a destruction of 
the alveolus. On the mesial surface of the second molar is an 
overhanging filling. The alveolus about the first molar is 
almost entirely absorbed. 

Fig. 45 

The alveolus on the distal surface of the upper left second 
molar and mesial of the third molar, is entirely destroyed. 
There is a small area of destruction of the alveolus between the 
first and second molar. Note the thickening of the peridental 
membrane of the second bicuspid and first molar. This con- 
dition always take place before there is any actual destruction 
of bone. 

Fig. 46 

The alveolus about the lower right first molar is entirely 
destroyed. It is remarkable how such teeth remain in the 
mouth with no supporting tissue. On close observation it can 
be seen that the occlusal surfaces of the teeth have been worn 
down. This probably is the cause of the alveoloclasia. 

Fig. 47 

Alveolar absorption present between second and third 
molars. The third molar is partially impacted. There is a 
small pocket between the first and second molars. 

Fig. 48 
Considerable alveoloclasia present about all the three molars. 

Fig. 49 

The first molar has been extracted and as a result the second 
molar is drifting forward. This condition invariably results in 
the production of alveolar absorption which is seen on the 
mesial of the second molar. In addition there is a generalized 
pericementitis due to lack of proximal contact. 



Interpretation of 'Dental 'Radiographs 



*$b- 



-jsv 



ALVEOLOCLASIA {Alveolar Absorption) 



HP 



TTC^ 




Fig. 50 



Fig. s 1 



* 





Fig. 52 



Fig. 53 



rut 



^ 



f t 





Fig. 54 



Fig. 55 



-*>{ 36}* 



liitter 'Denial '^htjcj. Qompany, Inc. 
«^ f — isv 

Fig. 50 

The alveolus about these teeth has been entirely destroyed. 
Note the considerable thickness of the peridental membrane 
about these teeth at the apex. This is thought to help hold 
the tooth in place after the alveolus has been destroyed. 

Fig. 51 

Considerable absorption of the alveolus present about the 
bicuspids and first molar. The crown portion of the first 
bicuspid shows the presence of caries. The second bicuspid 
has a large inlay on its distal surface extending down to the 
root portion and shows secondary decay underneath the inlay. 
The root canal is partly filled. Just below these teeth the bone 
is seen as being very dense and white. This is due to a con- 
densing osteitis probably the result of traumatic occlusion. 
Normal bone should not show this predominance of white 
but should show a harmonious blending of the white and dark 
areas. 

Fig. 52 

Alveolar absorption present about the left central and lateral 
extending almost to the apex. There is a large space present 
between the porcelain crown of the left central and the root 
portion of this tooth. 

Fig. 53 

Alveoloclasia present about the lower incisors. Note how 
the dark areas surround the teeth almost in their entirety. 
Also note the thickening of that part of the peridental mem- 
brane which is still intact. 

Fig. 54 

Same as Fig. 53. In addition however deposits of salivary 
calculus can be seen on the mesial and distal surfaces of these 
teeth. These salivary deposits show as small gray irregular 
bodies attached to the teeth. Note how the incisal edges of 
the teeth have been worn down. 

Fig. 55 

The superior left lateral shows the presence of alveolar ab- 
sorption due to the pressure of an extension bridge on it. 



ti'Blt 



Interpretation of 'Denial 'Radiographs 



-jsv 



FRACTURE 




Fin. ,-6 




'fitter T)ental <J%Cj'g. Qompany, Inc. 
va t — 1SV 

Fig. 56 

Shows a jagged dark space in the lower right bicuspid region, 
indicating a fracture. It should be noted that this dark space 
extends entirely through the mandible. This fracture was due to a 
bullet wound. The appliance (seen in white) extending around 
the buccal surfaces of the teeth is used to hold the broken parts 
in apposition. In the upper jaw there is considerable absorp- 
tion of the aveolar process present. 

Fig. 57 

Shows a dark line indicating a fracture, passing almost 
vertically through the mandible in the region of the second 
molar. The second molar is right in line of the fracture. There 
is a slight displacement of the fractured parts. Note the broad 
dark line extending forward from the ramus running along 
beneath the molar and bicuspid teeth and terminating in the 
dark space which is the mental foramen. This dark line is the 
inferior dental canal. 



-*£ 39 }<*■- 



vol. 



Interpretation of T>ental 'Radiographs 



FRACTURE 



46V 




Fig. 58 




i 



Fin. ?9 



^ 



Fig. 60 



'filter 1)ental zJtfCjg. (Company, Inc. 
van nsy 

Fig. 58 

Indicates a fracture of the root of the superior left central. 
The dark line which is the space between the two broken parts 
of the tooth is indicative of a fracture. 

Fig. 59 

This radiograph shows a fracture extending obliquely up- 
ward from the angle of the jaw through the second molar. 
The mesial root of this tooth is broken away from the tooth. 
There is no displacement of the parts. Immediately beneath 
the second molar and the body of the mandible is a gray semi- 
circular object which is the hyoid bone. To the right of the 
ramus is a dense white column which is the vertebral column. 

Fig. 60 

Shows a fracture extending horizontally through the root 
of the left upper central. Very often it is difficult to distin- 
guish a fracture of this kind when there is no displacement or 
separation of the parts. In such cases it becomes necessary 
to exert pressure on the crown of the tooth while the radiograph 
is being taken. This pressure will separate the broken frag- 
ments of the tooth if a fracture is present, and the radiograph 
will accordingly disclose it. 



-*C4» >*- 



Interpretation of Dental ^Radiographs 



VM- 



-»6* 



Osteitis, Osteomyelitis and Thin Portions ot Bone 





Fig. 6i 



Fig. 6: 



hi** 



la 



m 



Fig. 6; 




; ig. 6j 



■•*>{ 42 }<*- 



Twitter T)eut(il zJfCj'g. Company, Inc. 

Figs. 6i & 62 

Fig. 61 represents a radiograph of the lower left bicuspid and 
molar region. A dark area of considerable extent is present 
extending from the second bicuspid through the molars. Fig. 
62 was radiographed after 61 and it represents the lower right 
bicuspid and molar region. It also shows a similar dark area. 
These dark areas both are normal. They represent thin por- 
tions of bone found sometimes in the region of the angle oi the 
lower jaw. Usually this condition is bilateral and a radiograph 
taken of both sides will show similar radiographic appearance. 

Fig. 63 

The lower centrals show root canal fillings in them extending 
in one case through the apex and in the other, just short of 
the apex. There is a large diffuse dark area involving the bone 
about all the incisors and extending downward. This dark 
area is irregular in outline, gradually merging into the surround- 
ing healthy bone. This is a case of osteitis. 

Fig. 64 

Shows an osteomyelitis of the entire superior maxilla. The 
bone presents a mottled appearance. It also presents a worm- 
wood appearance. Note that the cancelli found in normal bone 
are entirely lacking here. The edge of the bone extending from 
the left central to the first bicuspid, is irregular in outline, and 
many loose fragments of bone are present here. 



-«>C 4-3 ><*- 



SirfStL 



Interpretation of 'Dental 'Radiographs 



-)GV 



OSTEOMYELITIS 




Fig. 65 



-*H[ 44 ><*- 



'I^ilter 'Dental zJXifg. Company, Inc. 

VS'll — II6V 

Fig. 65 

Shows an osteomyelitic involvement of the entire mandible. 
Note the wormwood appearance of the bone and the dark 
channels passing through it. This radiograph presents a 
typical picture of osteomyelitis. 



-:144 s >*- 



V3I. 



Interpretation of Dental ^Radiographs 



-jsv 



HYPERCEMENTOSIS 




Fig. 66 





Fig. 67 



Fig. 6-A 





Fig. 6S 



Fig. 69 



-:>C 46 >* 



'Ratter 'Dental zJ^Cfg. Company, Inc. 
va t lev 

Fig. 66 

Shows a case ot hypercementosis, sometimes known as 
exostotis. This condition is the result of the increased pro- 
duction of cementum. It is characterized in the radiograph 
by an increase in size of the root where this process occurs. 
It is seen in this radiograph as a mesio-distal enlargement 
of the mesial root of the lower left first molar. In short the 
root instead of tapering as it normally does, bulges out. Note 
the marked generalized thickening of the peridental membrane 
about this tooth and the other teeth in this radiograph. At 
the junction of the apical and middle thirds of the root (mesial 
side) of the second bicuspid, hypercementosis is present. In- 
variably hypercementosis at this point is indicative of trau- 
matic occlusion. 

Fig. 67 

The lower right first molar shows a filling entering the pulp 
chamber. There is a small thin regular white body in the 
mesial root of this tooth which is a broken fragment of a broach. 
There is a hypercementosis of both roots present. 

Fig. 67A 

The upper right second bicuspid shows a root canal filling 
extending part of the way to the apex. Note the mesio-distal 
enlargement of the root of this tooth (hypercementosis.) 

Fig. 68 

The superior right second bicuspid is carrying a crown and 
a pontic. The stress on this tooth has caused the production 
of a hypercementosis. 

Fig. 69 

Shows an involvement of the pulp chamber of the lower 
right first molar. The roots of this tooth both show mesio- 
distal enlargements which is indicative of hypercementosis. 



-*H[ 47 }*■ 



<*s(t 



Interpretation of 'Denial 'I(adio(jrapIn 



-JSV 



SCLEROSIS {Condensing Osteitis) 




Fig. 70 



-H48><* 



'Rjtter 1)enfal zJXCfg. Company, Inc. 

V5K I 16V 

Fig. 70 

Shows a grayish body extending downward from between 
the two lower first and second molars almost to the lower 
border of the body of the mandible. This is known as sclerosis 
or sclerotic bone. The patient in this case reported a fracture 
of the jaw some years previously. The bone instead of healing 
as it should normally and presenting the usual cancellated 
appearance, shows this grayish area without the presence o\ 
cancelli. This sclerotic bone is the result of a process of con- 
densing osteitis. As was explained previously in the text, 
great care should be taken not to confuse this scar bone with 
new normal bone formation. Normal regenerated bone appears 
almost like normal cancellous bone except that it is a little 
lighter in shade. It has both characteristics of normal alveolar 
process. Sclerotic bone presents a uniform white or gray 
appearance and has no cancelli. 



-*{ 4.9 >»•- 



VeX- 



I titer pretation of JJental T\adiographs 



-lev 



SCLEROSIS (Condensing Osteitis) 



1 ' 



I 





Fig. 71 



Fig. 




4 



r> 



Fig. 73 



Fig. 74 





Fig. 75 



Fig. 75 A 



*>£ 5°}<*- 



'I^ittcr 'Dental zJWfg. Company, Inc. 

Fig. 71 

Shows a small radiolucent area about the apex of the right 
upper cuspid. Immediately around this dark area is an area 
of dense white bone which is unlike normal bone. This is 
sclerotic bone and is thought to be a defense against the bone 
destruction that is taking place. 

Fig. 72 

Just mesially to the lower left second molar is a dense white 
circular object. It presents no cancelli and is homogeneous 
in appearance. This is sclerosis. 

Fig. 73 

Between the bicuspids on the upper left side is dense white 
bone. This is sclerotic bone. 

Fig. 74 

Just mesially to the lower left molar is present a dense gray 
area. This is sclerotic bone filling in the entire socket of the 
extracted molar. In this case the socket instead of healing 
or filling in with normal new bone, was replaced with this 
scar bone. 

Fig. 75 

Just mesially to the lower second molar near the apex, is a 
small circular gray body. This is sclerotic bone or a bone 
"whorl" or eburnated bone. The late Dr. Cryer reports that 
in very many cases these bone whorls are prolific causes of 
trifacial neuralgia. He reports that the removal of these bodies 
have been successful in the relief of this disease. Upon opera- 
tion these areas of sclerotic bone appear dense and hard. 

Fig. 75A 

Just beneath the lower right second molar is a small round 
white body. This is sclerotic bone. In the pulp chamber 
there are two pulp stones, (small gray bodies). 



H»f 5 1 >w- 



vat 



Interpretation of 'Dental 'Radiographs 



-IJSV 



ODONTOMA AND STONE IN DUCT 




Fie. 76 





■ 




Fig. 77 



Fig. 78 



■M. 5 2 >* 



T\itter 'Dental zyiifg. (/ompany, Inc. 

va n i .'isv 

Fig. 76 

The radiograph in this case was taken to determine what was 
preventing the eruption of the lower right first permanent 
molar. The x-ray shows that a large odontoma is preventing 
this tooth from erupting. The odontoma here shown is made 
up of the second and third molars. It shows as a large, light 
area in the bone. These odontomas are tooth tumors being 
made up of the enamel dentine and cementum. Upon operation 
this mass was found to contain about fourteen separate ami 
distinct denticles or tooth particles. The permanent cuspid 
and bicuspids are seen immediately underneath the temporary 
teeth. 

Fig. 77 

Shows a small gray body immediately beneath the left 
lateral and cuspid. This is a stone in the duct of the sublin- 
gual gland. The patient in this case presented himself at the 
clinic complaining of very severe pain in the floor of the mouth. 
There was extreme swelling present and also an excessive flow 
of saliva. A radiograph was taken which disclosed this deposit 
of calculus in the duct. 

Fig. 78 

The radiograph in this case was taken to determine what 
was preventing the eruption of the upper right central. This 
tooth is shown in the radiograph lying almost horizontally 
and pressing against the left central. Immediately beneath 
this impacted right central are about five or six dense white 
bodies clustered together. This is an odontoma. The tempo- 
rary right central is seen present. 



-*£ 5 3 }<*•■ 



t/5Xl_ 



Interpretation of 1)entcd l^adiographs 



-3GV 



SHARP POINTS OF PROCESS 
AND BROKEN NEEDLE 




Fig. 79 




Fig. 80 



-*{ 54 >*- 



filler L Daifal iJXCfg. Company, Inc. 
van n«v 

Fig. 79 

Shows the dark areas representing the sockets of the lower 
right first molar. At the extreme ends of these sockets are to 
be seen white sharp points extending upward. These are 
sharp points of process which give considerable pain and dis- 
comfort if not trimmed down. 

Fig. 80 

In the ramus of the mandible slightly above the lower molar 
teeth is a fine, thin, even white line about five-eights of an inch 
in length. This is a needle which was broken off during the 
administration of a mandibular injection. 



-*€ 5 5 >*- 



VS('= 



Interpretation of JJental 'Radiographs 



ilfcSV 



IMPACTED AND UNERUPTED 
AND DEVELOPING TEETH 





Fig. 82 



Fig. si 



Fig. 83 




Fig. 84 



•i(„ 87 



Fie. 



-*C 5 6 >* 



i\itter jJental sJKfg. (/ompany, Inc. 

Fig. 8i 

Shows two superior centrals which have not as yet com- 
pletely formed. Note the extreme width of these teeth. They 
are almost one and a half times as wide as the average tooth. 

Fig. 82 

Shows a supernumerary tooth above the left upper central. 
The lateral and cuspid have wide open apices. These apices 
have not as yet fully formed and should not be mistaken for a 
pathological condition. In the case of wide open apices due 
to incomplete development of these teeth, the lamina dura 
which is the white line surrounding the peridental membrane 
appears intact around the entire tooth. 

Fig. 83 

Shows a left central with the incisal edge and crown portion 
pointing upward. 

Fig. 84 

Shows a supernumerary tooth above the superior left central. 
The lateral apex has not as yet fully formed. 

Figs. 85 & 86 

Show the bicuspids present beneath the temporary molars. 
In both cases the permanent first molars have erupted. Note 
how the bicuspids appear to be lying in a sac with a white 
line surrounding this dental sac. 

Fig. 87 

Shows two supernumerary teeth (unerupted), one between 
the centrals and one above the right central. 



-*H[ 5 7 }<*•- 



Interpretation of iJental T\adiograph.s 



Ve>(l- 



-»€V 



IMPACTED AND UNERUPTED TEETH 





Fig. 88 



Fig. 89 





V 



Fig. i) 



•ic. 91 




Fin. 92 



-*>£5 8}<*- 



fitter 'Dental zJ&jy. Company, Inc. 
van — — K 5V 

Fig. 88 

Shows an unerupted third molar pressing against the second 
molar. 

Fig. 89 
Shows an impacted lower right bicuspid lying horizontally. 

Fig. 90 

Also shows a lower right impacted bicuspid lying lingually 
to the second molar. 

Fig. 91 

Shows an impacted bicuspid lying horizontally with crown 
portion pointing towards the observer. The dark area with 
the white line about it is a space or sac in which the tooth is 
lying. 

Fig. 92 
Shows an impacted upper right cuspid. 



•*H[ 5 9 }<*■■ 



*eXl- 



1 titer ■pretation of 'Dental Radiographs 



JKSv 



SINUSITIS 




Fig. 93 



-•»{ 60 }*- 



^Ritter 'Dental <zJMfg. Company, Inc. 

«^ f — — - la * a 

i 

Fig. 93 

The triangular spaces above the upper molar teeth and just 
below the dark circular spaces representing the orbits are the 
maxillary sinuses. The left sinus (observer's left) appears 
gray in comparison to the right sinus which is dark. Nor- 
mally the sinuses being spaces in bone should appear black. 
However, if they become rilled with fluid, pus, or some growth, 
they naturally will appear gray in the radiograph. The only 
way a diagnosis can be made radiographically as to whether a 
sinusitis is present is to take an antero-posterior view and 
compare the relative densities of the sinuses. The one that 
appears gray, (or if both appear gray) is the affected sinus. 



-*H[ 6 1 }<:-- 



Index 

A Page 

Abscess — Alveolar 12, 24, 25, 26, 27 

Alveolar absorption . 13, 34, 35, 36, 37 

Alveolar process — sharp points 54, 55 

Alveoloclasia . . . 13, 34, 35, 36, 37 

Amalgam filling — radiographic appearance 1 

Anatomic landmarks found in upper and lower jaws . .2, 3, 4, 5, 6 

Anterior palatine foramen 2, 4 

Antrum of Highmore or maxillary sinus 2,4 

B 

Bacteria — radiographic appearance of changes pro- 
duced by them in dental tissues 9 

Bone — radiographic appearance of normal bone 2 

Bone — radiographic appearance of abnormal bone . . ... 2 

C 

Caries — radiographic appearance 5, 13, 22, 23 

Cementum — radiographic appearance ... 1 

Chemicals — radiographic appearance of changes pro- 
duced in dental tissue by the action of chemicals 9 

Chlora percha, or gutta percha — appearance in radiograph .... 1 

Coronord process 2 

Cyst . 13, 28. 29,30,31,32 

Cyst — dentigerous 28, 29 

Cyst — multilobular, Fig. 38 50, 51 

D 

Defense — radiographic appearance of changes it pro- 
duces in dental tissues 10, 24 

Dental tissues — appearance of normal dental tissue in 

a radiograph 1 

Dentine 1 

Determination as to whether a dark or radiolucent 
area in bone is due to some pathological condition 

or not 6, 7 

Developing teeth .... • ■ • 5°> 57 

Diagnosis of pathological conditions II, 12, 13, 14, 15 

Differentiation between cyst and granuloma 12 

Distinguishing right and left sides in a radiograph 7, 8 

E 

hnamel ' 

External oblique line or ridge 6 



'Twitter 1)ental <^Cj(j. Company, Inc. 
VS X l — IKSV 

F 

Factors producing disease of dental tissues g, 10 

Filling materials — radiographic appearance i 

Fracture 38, 39, 40, 41 

G 
Granuloma 12, 20, 21, 22, 23 

H 

Hypercementosis 14, 46, 47 

I 

Impacted teeth 5^, 57, 58, 59 

Inferior dental canal 5, 6 

Irritation, (mild) radiographic appearance of changes 

it produces in dental tissues 9 

L 

Lack ot occlusion — radiographic appearance of changes 

it produces 9 

Lack of proximal contact — radiographic appearance 

of changes it produces in dental tissues 9, 19, 20 

Lack of use of teeth — radiographic appearance of 

changes it produces in dental tissues ... 9 

Lamina dura 1,2 

Lingual tubercle 4, 6 

M 

Malar bone 2, 4 

Mandibular canal 5, 6 

Mental foramen 4, 6 

N 

Nasal cavity 2, 4 

Nasal septum 2 

Necrosis 13 

Nostril spots 2 

O 

Odontoma 52 

Osteitis 13, 42 

Osteomyelitis ... 13, 42, 43, 44j 45 

Osteo-sclerosis 10 

Overhanging fillings (Fig. 4) 16 

Oxy-chloride of Zinc 1 

Oxy-phosphate of Zinc 1 



Interpretation of 'Dental 'Radiographs 
vat |gy 

P 

Periapical absorption — diffuse ...:... . 24, 25, 26, 27 

Periapical disturbances .... 11 

Pericementitis .' 1 1, 16, 17, 18, 19 

Peridental membrane — normal radiographic appearance 1 

Periodontitis 11, 16, 17, 18, 19 

Pressure — radiographic appearance of changes it pro- 
duces in dental tissues 9 

Pulp stones 14, 16 

R 

Regeneration of bone 14 

Regeneration of bone — difference between normal 

newly-formed bone and sclerotic bone 14, 49 

S 

Salivary calculus (Fig. 6) 16 

Salivary deposits in ducts of glands 14,54,53 

Sclerosis of bone 10, 14, 48, 49, 50, 51 

Sharp points of alveolar process 54, 55 

Sinusitis 14, 60 ,61 

Supernumerary teeth 56, 57 

T 

Thermal shock — changes it produces in bone 10 

Thin portion of bone at angle of jaw 6,42,43 

Traumatic occlusion, changes it produces in dental tissues . 10, 16, 17 

U 
Unerupted teeth 5^, 57, 58, 59 



-*H[ 6 4 ]K*- 



Definitions of Terms Used 

Attrition — Wearing away of the occlusal or incisal surfaces of the teeth. 

Alveoloclasia — Absorption of the bone of the alveolus. 

Alveolus — The socket of the tooth. 

Bone whorl — Small round area of sclerotic or dense bone. 

Cancelli — A network made up of the fibres of spongy bone (cancellous bone). 
In the radiograph it appears as a white network enclosing irregular black 
spaces. 

Cancellous Bone — The spongy bone found between the dense outer plates 
of bone. 

Caries — Decay of tooth. 

Condensing osteitis — Inflammation of bone resulting in the formation of 
hard dense bone. 

Cyst — A sharply defined area containing an abnormal collection of fluid and 
is unprovided with a channel for outflow of this fluid. They have a distinct 
lining membrane. 

Distal surface of tooth — That surface of the tooth farthest away from the 
median line. 

Eburnated bone — Hard dense bone — see bone whorl. 

Excementosis — Increase in the amount of cementum forming an enlarge- 
ment cir bulging out of the root of the tooth. 

Exostosis — In dentistry same as excementosis or hypercementosis. 

Granuloma — An inflammatory new growth of tissue due to some mild form 
of irritation or infection. Radiographically it appears about the apex of the 
tooth or in edentulous areas as a small localized dark area with a distinct 
white outline. 

Hard Tube — X-ray tube of high vacuum resulting in the production of 
X-rays of great penetration. 

Hypercementosis — Same as excementosis. 

Lamina dura — A thin layer of dense bone lining the sockets or alveoli of the 
teeth. 

Mesial surface — That portion or surface of the tooth nearest the median 
line. 

Necrosis — Disorganization and death of tissue usually due to deprivation 
of nutrition. 

Occlusal surface — The grinding s'urface of the bicuspids and molars. 

Odontoma — A tooth tumor — a tumor in connection with teeth or made up 
of dental tissues. 

-*M[ 6 5 }<*~ 



Interpretation of Dental J\gdiographs 
*™* ¥*>' 

Osteitis — Inflammation of bone. 

Osteosclerosis — Hardening of bone — see eburnated bone. 

Osteomyelitis — Inflammation of the marrow of the bone. 

Pericementitis — Inflammation of the peridental membrane. 

Peridental lamella — Another name for lamina dura. 

Peridental membrane — A fibro-elastic membrane interposed between the 
tooth and alveolus. 

Periodontitis — Inflammation of the peridental membrane. 

Pulp Stone — A small body or nodule present in the pulp chamber or canal. 
Radiographically it has same density as dentine. 

Radiograph (noun) — A resulting product (such as film or print) of the radio- 
graphic process. 

Radiograph (verb) — Act of making a radiograph. 

Radiolucent — That term which is applied to substances that allow X-rays 
to pass through but offer slight resistance to their passage. 

Radiopaque — Substances which do not allow X-ravs to pass through them. 

Radioparent — Substances allowing X-rays to pass through them and offer 
no resistance to their passage. 

Sclerosis of bone — Hardening of bone — see eburnated bone. 

Sinusitis — Inflammation of the sinuses. 

Subperiosteal — Beneath the periosteum. The periosteum being a fibrous 
membrane covering the bone. 

Supernumerary tooth — Tooth exceeding normal number. 

Traumatic occlusion — Abnormal occlusal or biting stress. 



■*:>{_ 6f> ]Hss- 



sJXCemonmda 



^hCemoranda 



THE DU BOIS PRESS 
ROCHESTER. N. Y.